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176868 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 356305 Page 1 of 1 I ONE CIVIC SQUARE DARRELL D NORRIS CHECK AMOUNT: $97.40 CARMEL, INDIANA 46032 101 2ND AVE Sw. u2C CARMEN IN 46032 CHECK NUMBER: 176868 CHECK DATE: 9/2/2009 DEPAR A CCOU NT PO NUMBE INVOICE NUMBE A DE 1160 4230100 13.90 STATIONARY PRNTD MA 1160 4343004 71.50 MILEAGE 1160 4355100 12.00 PROMOTIONAL FUNDS PRESC, ?+t.D BY STATE BOARD OF ACCOUNTS r GENERAL FORM NO. 101 (1986) MILEAGE CLAIM 0 17 Y e/ C /"TfO';Pc`t TO (GOVERNMENTAL UNIT ON ACCOUNT OF APPROPRIATION NO. FOR /4N )1O)e .r' C. 1160 (OFFICE, BOARD, DEPARTMENT OR INSTITUTION) DATE FROM TO SPEEDOMETER T +R AUTO MILEAGE NATURE OF BUSINESS MILES c POINT POINT START FINISH TRAVELED PER MILE 6 le P CL A Po C l-e 6VI Rd' 1© r, W Lic C' GLt TD 6--r- Cep. C" //&L oORS 5 AV Ge AUTO LICENSE NO. TOTALS Q 7/ SO SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is leg ly due, after allowing L'ust edi ts and that no pap of the, same has been paid. Date �t �2�' -�20 3 l Claim No, Warrant No. I have examined the within claim and hereby IN FAVOR OF certify as follows: That it is in proper form. V That it is duly authenticated as required by law That it is based upon statutory authority. That it is apparently correct incorrect Disbursing Officer On Account of Appropriation No. for o tr m 5 o o Allowed 19— A w ET- in the sum of m a Pi m o m m M Q o 0 n e (Board or Commission) 4 Q A. a FILED a m An m (Official Tide) 0 o a m A.E. ROYCE CO., INC. WVNCQ, GI 01136 5 URDERS, lzo L11 Hwv '31 Noi Carmel. IN 46032 7 BORDERS TRN:5263 BOOKS MUSIC AND CAFE 2381 POINT PARKWAY CARMEL, IN 46032 Ell 17 3 843-0450 S b t C) t al 6 D7 STORE 0504 REG: 02/59 TRAiJ 8798 ��ales ill 7. 44 A L E 08/27/2009 PERIODICAL R WO 0 1, FIMC Gr 0.70 074851054031 PR T 6,95 iiiani For SubtOtdl 91, 7% o INDIANA I Item Total 7.44 CASH 10.00 Cash Change Due 2.56 i sr.l rI III�I�I, �I� 08/27/2009 01)3: SPM cus I OMEV-1 CON, VIII i IIIlIIIIlIf Jill III V III ;6AJ AfI714211141OLe?,) i -0-0 a4av I vim✓ P lOwo 4-A cp 1 T� L8 (317)816-1200 ;elw d- ChEk :7603.3 Tab le r D at E 8 1rj 9 Time: 7:50: PH 1,', 76233 uiedk NumLer: lime: 7:30:27 PM clo-t—F—ff, Master Card C ard Type: CHI' BAG'A I Server Nawle: Emilie Che6Check Number: 7 6 2 33 t Sub- To B AMOUNT 9.22 Beverage END Q/ L i.a I 1 1.50 TIP Sales Tax 0.77 )o CUB TOTAL 8.45 V-2- 4k 4pprova 05" 051 TOTAL 9.22 THANK Y0J RETA TH COPY R YOUR RECORDS 'ORDS Emilie and thank you for your business `'Pres;.;iNffl by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee L<. Z� /V Purchase Order No. Vi C_ S CL Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) y e r01� J/1;X T7��2�f/✓' -✓ice 9sl Total I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 IN SUM OF �s 90 ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. f hereby certify that the attached invoice(s), or d3 0 coo bill(s) is (are) true and correct and that the e,` SYo?3o/ dd 6 1 ys" materials or services itemized thereon for 7' S'3 S o /d, o o which charge is made were ordered and received except 200 Signature Cost distribution ledger classification if Title claim paid motor vehicle highway fund